New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 46D - CONTRIBUTION TO CARE AND MAINTENANCE REQUIREMENTS
Subchapter 2 - FINANCIAL CRITERIA
Section 10:46D-2.1 - General standards
Current through Register Vol. 56, No. 6, March 18, 2024
(a) The individual or his or her legally responsible relative shall be responsible to apply for the Medicaid DDD Community Care Waiver and to maintain eligibility for these benefits. The individual or his or her legally responsible relative shall also submit complete financial information necessary to assess contribution to care prior to placement or the delivery of services by the Division.
(b) The individual or his or her legally responsible relative shall be responsible to comply with all requirements to maintain continued eligibility for the Medicaid DDD Community Care Waiver benefits during the time services are provided by the Division.
(c) At the time of an offer of placement, the individual, legal guardian and/or his or her LRR(s) shall be advised in writing by Division staff that it will be necessary to apply for the Medicaid DDD Community Care Waiver and all other benefits and to submit financial information in order for the Division to determine the ability of the individual and/or LRR(s) to contribute to the cost of care.
(d) The ability to contribute shall be reevaluated no less than annually, unless changed circumstances warrant more frequent evaluation as set forth at 10:46D-2.2(i). The individual, legal guardian, or other responsible parties shall provide all documents requested, including tax returns.
(e) The individual, legal guardian or other interested party may choose to manage the person's benefits.
(f) Although the individual is required to contribute to the cost of care, those contributions do not cover the full cost of care. The individual or other responsible parties remain responsible to repay the full cost of care if at some future point the resources become available to do so. For example, the Division may seek to recover the full costs of care when an individual comes into an inheritance.
(g) Eligibility for services shall not be denied if the other eligibility criteria are met, but the individual does not have the ability to contribute to the cost of care and maintenance. The individual shall be required to make a good faith effort to apply for benefits for which they may be entitled and comply with all the requirements for eligibility for benefits. If benefits are denied, the individual shall provide documentation of the denial that shall be included in the client record.
(h) Individuals who are 18 years and older or their guardians shall forward to the Division financial information concerning the individual as necessary to assess the contribution to care.
(i) For individuals who are under 18 years old, his or her legally responsible relative shall forward to the Division financial information concerning the legally responsible relative(s) as necessary to assess the contribution to care.
(j) Should an individual be residentially placed by the Division on an emergency basis, the information required for a financial determination is due at the regional office for the area in which the placement is located no more than 28 days following the date of placement. If the information is not provided within the required time frames, the Division may consider the individual's circumstances on a case-by-case basis. Failure to provide the required documentation may result in the Department seeking any of the remedies set forth in 10:46-5.1.
(k) Written material shall be provided in the individual's primary language as needed to the extent practicable and in accord with the guidance on language access provided by the U.S. Department of Health and Human Services (68 FR 47311); incorporated herein by reference.
